HomeMy WebLinkAboutBuilding Permit #697 - 175 SANDRA LANE 5/27/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: 6 (? Date Received -,�)''-L'9
Date Issued:C�c�%—c3
IMPORTANT: Applicant must complete all items on this Daize
LOCATION I? 6 SANy ZA L/l/ Al, P)POyCRA YM
Print
PROPERTY OWNER 1<7 NT 9 5TI' VE NS0 Al
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
!Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building dT/f�
One family
Addition
ore family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
!/VST.4 Ll �Oap 13urZ�•�yr sidy/_'
Identification Please Type or Print Clearly)
OWNER: Name: /rIZ N T %� STig ver N..Vd A/ Phone: 97 F
Address: 12)— <5A-,v0A A CAI /1i /9tiDgU/1,? o7A,
CONTRACTOR Name: S'v Al 2A Suit p 2 f .S` Phone: G 03 3 o d 6 9AtS`
Address: 120 a a X 32-/7 Y-17AA)C-#1ZS71Zf, , /t//Y
Supervisor's Construction License: Exp. Date:
Home hDrovement
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
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Total Project Cost: $ FEE: $ 120.
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
of A
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/MassageBody Art
Swimming Pools
Well,
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
`' Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes,
Located at 124MainStreet.
Fire Department signatureldate
COM
Located 384 Osgood Street
no
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NU 1 t5 and DATA — (For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
No
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ -Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
guilders
P.O. Box 3217 Manchester, NH 03105-3217
Tel. (603) 300-6915 Fax (603) 622-0658
SUBMITTED TO
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CITY, STATE AND ZIP
PHONE -
EMAIL ADDRESS
JOB NAME -
JOB LOCATION -
JOBPHONE
DATE•
IKA I to] 0 101113
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WE PROPOSE HEREBY TO FURNISH MATERIAL AND LABOR — COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS, FOR THE SUM OF:
1�1
P,
DOLLARS ($
PAYMENT TO BE MADE AS FOLLOWS:
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner
according to standard practices. Any alteration or deviation from above specifications involving extra
costs will be executed only upon written orders, and will become an extra charge over and above the
AUTHORIZ�p/.,if/
estimate. All agreements contingent upon strikes, accidents or delays beyon d our control. Owner to
carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's SIGNATURE
Compensation Insurance.
ACCEPTANCE OF CONTRACT- THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED.
YOU ARE
AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE.
SIGNATURE 12
f7e -DATE
SIGNATURE nATP:
Gerald A Brown
Inspector of Buildings
Pleasc print
DATE: 512 7 A4
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
Telephone (978) 688-9545
Fax (978) 688-9542
JOB LOCATION: C ,� 5.4 Nn414 e -Al /i/ A tvv po 2 "W A
Number Street Address Map/Lot
HOMEOWNER A'YlY r- 9 STi9 vi2 NI a n/ 9 7 G F.F3 6 7 6 #11A
Name Home Phone Work Phone
PRESENT MAILING ADDRESS /7 s— sT-A ,,vV e A &,V- n A 0/ j7-;�S—
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the
owner acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, oris intended
to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable Codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that helshe understands the Town of North Andover Building Department
minimum inspection procedures and r prements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Rid 10.2005
Form Homwwn= Fmmption
BOARD OF �PPE.V-S 699-9541 C0.N1,qFR%'_1T[O\ 6F8-9530 ITE.U.•I•H 689-95.30 PLANNING 6F8-9535
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Location
No. l 9 � Date
NORTH TOWN OF NORTH ANDOVER
• OL
9
Certificate of Occupancy $
CNst<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ Lin• ar
Check #
2 84
f/ — Building Instor